Chinese expert consensus on shape-sensing robotic-assisted bronchoscopy (ssRAB) in the management of peripheral pulmonary lesions

Abstract

Background: Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a new bronchoscopy technology that utilizes optic fibers to provide accurate position information and robotic-control to deliver improved maneuverability. This technology has been used in the United States since 2019 and investigated in China since 2021. In order to provide a standard practice and make the best use of this technology for managing peripheral pulmonary lesions (PPLs), experts developed the consensus. Methods: This consensus was developed using Delphi method. A panel comprising nine experts formulated eight consensus statements after a thorough review of clinical evidence and practical experience. During the second phase, a questionnaire was distributed to collect feedback on these statements from an external panel of 39 physicians. The percentage of responses and the percentage of agreement on each statement were calculated. The consensus was defined as achieved with an agreement percentage threshold of 80% or above. Results: The eight consensus statements formulated in phase 1 included recommendations for path planning, anesthesia, the use of radial endobronchial ultrasound (EBUS), the use of fluoroscopy and/or cone-beam computed tomography (CBCT) with ssRAB, solving computed tomography (CT)-to-body divergence, the use of sampling tools with ssRAB, cloud biopsy, and the use of rapid on-site evaluation (ROSE) with ssRAB. All panel physicians completed the questionnaire in phase 2. All the statements achieved positive consensus, with six receiving 100% agreement and two reaching 97.4% agreement. Conclusions: The document establishes a consensus on recommended practices for optimal utilization of ssRAB technology in the management of PPLs. The guidelines will be updated as new evidence emerges or additional ssRAB platforms are introduced into practice.